To save a baby, rescue a mother

Rozetta Timmons had a $100-a-day heroin habit and no intention of quitting. Then she got pregnant.

Determined not to have a drug-addicted baby, she recalled two women who had been canvassing her neighborhood, looking for pregnant women. They had tried to tell her about something called the Baltimore Project, at the old Douglass High School, but Timmons hadn't been interested. Now she was.

So she went to the old school, looking for a woman she could describe only as having long hair and pretty eyes. It turned out to be Miriam Watkins, an addiction specialist. Within minutes, Watkins had scheduled Timmons' first prenatal visit. Within months, she would have Timmons off heroin.

Timmons, 24, who gave birth to a premature but drug-free boy in April, is considered a success story at the Baltimore Project, an experimental program in the Sandtown-Winchester neighborhood, just west of downtown Baltimore. The two women who had first tried to tell her about the Baltimore Project were two of the program's community-health advocates.

The fledgling program is trying to reduce the infant mortality rate through an aggressive campaign to find pregnant women and help them to take care of them selves and their unborn babies.

Its advocates go door-to-door in neighborhoods, much like City Council candidates. But as they knock on doors, their pitch to the residents is decidedly different: "Are there any pregnant women in there? Do you know any?"

This hands-on approach doesn't end at the street. A woman enrolled in the Baltimore Project soon finds that the program's scope extends far beyond prenatal care.

Trouble with your welfare check? An advocate can talk to your social worker. Problems with housing? Advocates will try to find you a new place to live. Lose your house keys? Your advocate will call a locksmith and get you a new set.

The four-member teams are available 24 hours a day. They check in with their clients frequently, dropping in like neighbors. In many cases, they are neighbors, recruited for their community ties.

"Most programs wait for the women to come to them," said Daisy Morris, the project's director. "We operate just the opposite. We assume we have something really good to offer, but no one's going to know about it unless we tell them."

Morris maintains that poor prenatal care is often the result of a lifestyle -- poverty, lack of family support, drug and alcohol use -- that overwhelms an expectant mother.

For a woman who has locked herself out of her house or had a fight with her landlord, Morris said, getting to a doctor's appointment becomes a low priority. For a woman using drugs, the doctor may become another authority figure to be avoided.

"We're basically going back to doing what we were doing 20 years ago," said Morris. "If the statistics prove us right, the real test is if this concept can work with other places."

HEALTHY START

The Baltimore City Health Department is not waiting for

statistics to test the Baltimore Project's concept.

The urgency of the city's infant mortality problem, coupled with an opportunity for a large federal grant, has pushed the department into an ambitious proposal for the city's poorest areas, based on the Baltimore Project model.

"There's a high degree of frustration, a chasm between what we know and what we could do," said Thomas P. Coyle of the City Health Department. "But, for the first time, there is an answer."

Coyle's answer is Healthy Start, which would be the Baltimore Project 10 times over. The city is applying for millions in federal grant money to set up 10 "service areas" in the city's poorest neighborhoods. Although the target areas account for only 65 percent of the city's births, they account for 80 percent of its infant deaths. An average of 173 babies die every year in these neighborhoods.

Healthy Start proposes to cut that number in half within five years. While it is modeled on the Baltimore Project, it includes some new components -- family planning to reduce the teen-age birth rate and overall fertility rate, and preventive health care for women and men, so their children will be healthier.

Year in and year out, Baltimore has one of the nation's highest rates of infant mortality. When the figures are broken down by race, the city is consistently No. 1 in deaths of white infants and in the top 10 for blacks.

Low birth weight, one of the leading factors in infant deaths, is an even bigger problem. More than 12 percent of the city's babies weigh less than 5 1/2 pounds at birth. Those who survive may face a lifetime of medical complications and developmental problems.

That rate frustrates city health officials because they know the remedies -- early prenatal care, nutrition counseling and avoiding drugs, alcohol and cigarettes.